Systems And Methods For Providing A Pulse Of A Therapeutic Gas With A Desired Flow Profile To Maximize Therapeutic Effectiveness

ABSTRACT

Described are systems and methods for providing a pulse of a therapeutic gas with a desired flow profile to maximize therapeutic effectiveness. Systems and methods of the present disclosure can generate and/or provide desired flow profiles with various shapes and/or properties by configuring, modifying, optimizing, and/or factoring in aspects of at least one fixed flow rate assembly of a therapeutic gas delivery system such as, but not limited to, spatial relationships of elements of the fixed flow rate assembly, rate of valve closure and opening, latent flows, transient wave generation and/or propagation, to name a few.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation under 35 U.S.C. § 120 of U.S. patentapplication Ser. No. 14/886,556, filed Oct. 19, 2015, which claims thebenefit under 35 U.S.C. § 119(e) to U.S. Provisional Application No.62/065,046, filed Oct. 17, 2014, the entire contents of which areincorporated herein by reference in their entirety

FIELD

The present disclosure generally relates to systems and methods forproviding a pulse of a therapeutic gas with a desired flow profile tomaximize therapeutic effectiveness.

BACKGROUND

A number of gases have been shown to have pharmaceutical action inhumans and animals. One such gas is Nitric oxide (NO) that, wheninhaled, acts to dilate blood vessels in the lungs, improvingoxygenation of the blood and reducing pulmonary hypertension. Because ofthis, NO can be provided as a therapeutic pharmaceutical drug in gasform in the inspiratory breathing gases for patients with diseases(e.g., pulmonary hypertension).

The dosing of an inhaled pharmaceutical drug in gas form can be based onnumerous variables. For example dosing can be based on the quantity ofdrug (usually in weight) per unit weight of the patient (e.g., mg/Kg)with the dose being specified to be delivered over a period of time orbeing repeated at specified intervals of time. This can allow users tocontrol the quantity of drug and ensure the quantity of drug beingdelivered is in proportion to the patient's size. Further, this dosingtechnique can reduce the patient to patient variability in response tothe drug due to the size of the patient (i.e. a 7 Kg baby will not getthe same quantity of drug as a 80 Kg adult). Of course other techniquesand/or variables can be used for dosing.

The dosing of a pharmaceutical drug in gas form for a pharmaceuticalaction and/or for a specific disease can have a tight window between thetherapeutic level for the pharmaceutical drug and the level that causesharm. For example, various quantities of pharmaceutical gas can providebenefits to patients; however, if a pharmaceutical gas is delivered intoo high a quantity then harm can be caused to a patient. For anotherexample, timing delivery of pharmaceutical gas to various points duringinspiration can provide benefits to patients; however, if delivery istimed to other points during inspiration the beneficial effects can bediminished and/or harm may be caused to a patient.

In light of at least these tight windows, it would be beneficial todeliver doses of a pharmaceutical drug in gas form to patients withspecific flow profiles. However, these dosing flow profiles can besubstantially complex and/or can require substantially accurate andprecise quantities of gas that may be substantially small and/or thatmay vary with respect to substantially short durations of time. Further,generating and/or providing dosing with these specific flow profilesthat have such requirements can be substantially difficult and requirespecific delivery systems that may require the use of expensivecomponents. These expensive components can increase the cost of suchsystems, reduce availability to the public, and/or utilize resourcesthat may be limited.

Accordingly, it would be advantageous to have a system and method thatcan accurately and precisely generate and/or provide pharmaceuticalgases with specific desired dosing flow profiles. It would also beadvantageous to have such as system and method be fabricated and/orutilize techniques that reduce costs, for example, to increaseavailability to the public and/or more effectively allow for use ofresources.

SUMMARY

One aspect of the present invention relates to a system for providing apulse of a pharmaceutical gas having a desired flow profile to deliverto a patient. In various embodiments of this aspect, the systemcomprises a first fixed flow rate assembly including a first fixed flowvalve in fluid communication with a first fixed flow orifice, the firstfixed flow valve being (1) a fixed flow valve that rapidly opens andrapidly closes, (2) located upstream or downstream of first fixed floworifice and (3) at a volumetric offset from the first fixed floworifice; and a flow delivery control that rapidly opens and rapidlycloses the first fixed flow orifice located at least one of upstream ordownstream of, and at the volumetric offset from, the first fixed flowvalve to provide a pulse of a pharmaceutical gas having a desired flowprofile to a patient.

In exemplary embodiments, the pulse of a pharmaceutical gas having adesired flow profile may provided to a patient to treat a specificdisease, such as at least one of chronic obstructive pulmonary disease(COPD), idiopathic pulmonary fibrosis (IPF), and pulmonary hypertension(PH).

In exemplary embodiments, when the first fixed flow orifice is upstreamto the first fixed flow valve at least one of (1) an initial flow spikein volume of transient therapeutic gas substantially equal to the volumein the volumetric offset is delivered when the first fixed flow valve isopened rapidly, and (2) a sharp cutoff is provided when the first fixedflow valve is closed rapidly.

In exemplary embodiments, when the first fixed flow orifice isdownstream to the first fixed flow valve at least one of (1) a sharpturn on is provided when the first fixed flow valve is opened rapidly,and (2) a waning flow having a volume substantially equal to a volume inthe volumetric offset is provided when the first fixed flow valve isclosed rapidly.

In exemplary embodiments, when the first fixed flow orifice is upstreamfrom the first fixed flow valve, the volumetric offset is substantiallyminimized to decrease duration of a waning flow generated when the firstfixed flow valve is closed rapidly. In some embodiments, the volumetricoffset has a volume of less than 1 mL. In some embodiments, the systemof claim 6, wherein the volumetric offset has a volume in the range of0.0005 mL to 0.1 mL.

In exemplary embodiments, the cannula or tube includes a dampener forringing.

In exemplary embodiments, the desired flow profile for the pulse ofpharmaceutical gas is one that minimizes the time that the first fixedflow valve is open. In some embodiments, the first fixed flow valveprovides a pulse having a pulse width of less than 500 milliseconds.

Another aspect of the present invention relates to a method of providinga pulse of a pharmaceutical gas with a desired flow profile to deliverto a patient, the method comprising rapidly opening a first fixed flowvalve that is located upstream from a first fixed flow orifice tocommence delivery of a first dose of a pharmaceutical gas in a pulsehaving a desired flow profile to a patient that abruptly increases flowto a desired initial flow rate over negligible time; rapidly closing thefirst fixed flow valve to end flow, through the first fixed flow valve,of the pharmaceutical gas; and providing a waning flow of thepharmaceutical gas after rapidly closing the first fixed flow valve tocomplete delivery, to the patient, of the pulse of the pharmaceuticalgas with the desired flow profile, wherein the waning flow is generatedin response to arranging the first fixed flow valve at a volumetricoffset from the first fixed flow orifice such that the waning flow is atleast one of reduced by lessening the volumetric offset or increased byincreasing the volumetric offset.

In exemplary embodiments, the pulse of a pharmaceutical gas having adesired flow profile is provided to a patient to treat at least one ofchronic obstructive pulmonary disease (COPD), idiopathic pulmonaryfibrosis (IPF), and pulmonary hypertension (PH).

In exemplary embodiments, the desired flow profile is downwardly slopedtriangular shaped.

In exemplary embodiments, the method further comprises maintaining openthe first fixed flow valve to continue delivery, to the patient, of thepulse of the pharmaceutical gas with the desired flow profile at adesired continued flow rate for a period of time. In some embodiments,the desired flow profile is quadrilateral shaped. In some embodiments,the volumetric offset has a volume of less than 1 mL and thequadrilateral is substantially rectangular shaped.

Another aspect of the present invention relates to a method of providinga pulse of a pharmaceutical gas with a desired flow profile to deliverto a patient, the method comprising rapidly opening a first fixed flowvalve that is located downstream from a first fixed flow orifice tocommence delivery of a first dose of a pharmaceutical gas in a pulsehaving a desired flow profile to a patient that abruptly increases flowto a desired initial flow rate including an initial flow spike overnegligible time, wherein the initial flow spike is generated in responseto arranging the first fixed flow valve at a volumetric offset from thefirst fixed flow orifice such that the initial flow spike is at leastone of reduced by lessening the volumetric offset or increased byincreasing the volumetric offset; rapidly closing the first fixed flowvalve to end flow, through the first fixed flow valve, of thepharmaceutical gas to complete delivery, to the patient, of the pulse ofthe pharmaceutical gas with the desired flow profile.

In exemplary embodiments, the pulse of a pharmaceutical gas having adesired flow profile is provided to a patient to treat at least one ofchronic obstructive pulmonary disease (COPD), idiopathic pulmonaryfibrosis (IPF), and pulmonary hypertension (PH).

In exemplary embodiments, the method further comprises maintaining openthe first fixed flow valve to continue delivery, to the patient, of thepulse of the pharmaceutical gas with the desired flow profile at adesired continued flow rate for a period of time.

In exemplary embodiments, the desired flow profile is quadrilateralshaped.

BRIEF DESCRIPTION OF THE DRAWINGS

The features and advantages of the present disclosure will be more fullyunderstood with reference to the following, detailed description whentaken in conjunction with the accompanying figures, wherein:

FIGS. 1A-1C illustratively depict exemplary desired flow profile forpulse doses of a pharmaceutical gas, in accordance with exemplaryembodiments of the present disclosure;

FIGS. 2A-2B illustratively depict an exemplary front panel ofapparatuses that may be used for carrying out at least some aspects ofthe present disclosure, in accordance with exemplary embodiments of thepresent disclosure;

FIG. 3 is an exemplary schematic view of apparatuses that can be usedand/or modified to carry out at least some aspects of the presentdisclosure, for example, with a spontaneously breathing patient, inaccordance with exemplary embodiments of the present disclosure;

FIG. 4 is an exemplary schematic view of apparatuses that can be usedand/or modified to carry out at least some aspects of the presentdisclosure, for example, with a patient being breathed by way of aventilator, in accordance with exemplary embodiments of the presentdisclosure;

FIGS. 5A-5D illustratively depict configurations for generatingexemplary desired flow profile, in accordance with exemplary embodimentsof the present disclosure;

FIGS. 6A-6D illustratively depict modifying at least exemplaryvolumetric offsets and/or generating initial flow spikes, in accordancewith exemplary embodiments of the present disclosure;

FIGS. 7A-7D illustratively depict modifying at least exemplaryvolumetric offsets and/or generating waning flows, in accordance withexemplary embodiments of the present disclosure;

FIGS. 8A-8D illustratively depict modifying at least exemplaryvolumetric offsets and/or generating pulse waves, in accordance withexemplary embodiments of the present disclosure;

FIGS. 9A-9D illustratively depict modifying at least exemplaryvolumetric offsets and/or generating waning flows, in accordance withexemplary embodiments of the present disclosure;

FIGS. 10A-10H illustratively depict exemplary volumetric offsets, inaccordance with exemplary embodiments of the present disclosure; and

FIGS. 11A-11B illustratively depict additional exemplary volumetricoffsets, in accordance with exemplary embodiments of the presentdisclosure.

DETAILED DESCRIPTION

In exemplary embodiments, systems and methods of the disclosure providepulse doses of a pharmaceutical gas with a desired flow profile tomaximize therapeutic benefits, for example, for patients suffering fromchronic obstructive pulmonary disease (COPD), idiopathic pulmonaryfibrosis (IPF), and pulmonary hypertension (PH), cystic fibrosis (CF),to name a few. The desired flow profile can vary for substantially smalldoses of gas with respect to substantially short durations of time.Generating and/or providing these desired flow profiles with asubstantially high degree of precision and accuracy can be difficult,but may be necessary to maximize therapeutic benefits. Noting thisdifficulty, systems and methods of the present disclosure can generateand/or provide desired flow profiles by configuring, modifying,optimizing, and/or factoring in aspects of at least one fixed flow rateassembly of a therapeutic gas delivery system.

Referring to FIGS. 1A-1C, in exemplary embodiments, desired flow profile100 for pulse doses of a pharmaceutical gas can vary for substantiallysmall doses of gas with respect to substantially short durations of timecan be delivered to a patient during specific points of the respiratorycycle 101. For example, desired flow profile 100 for pulse doses of apharmaceutical gas can be delivered to a patient, during patientinspiration, during at least the first half of patient inspiration,during specific points of a patient's respiratory cycle, etc. Further,in exemplary embodiments, desired flow profiles can include shapesand/or properties (e.g., flow rate at a specific time, spikes in flow,waning tails, etc.).

In exemplary embodiments, shapes and/or properties of desired flowprofiles for pulse doses of a pharmaceutical gas can be generated and/orprovided for a specific pharmaceutical action and/or for a specificdisease. For example, shapes and/or properties of desired flow profilesfor pulse doses of a pharmaceutical gas can be can be generated and/orprovided to provide benefits to patients suffering from COPD, IPF, CF,and PH, to name a few.

In exemplary embodiments, shapes and/or properties of desired flowprofiles can be generated and/or provided by configuring, modifying,optimizing, and/or factoring in aspects of at least one fixed flow rateassembly of a therapeutic gas delivery system such as, but not limitedto, spatial relationships of elements of the fixed flow rate assembly,rate of valve closure and opening, latent flows, transient wavegeneration and/or propagation, to name a few. By way of example, systemsand methods of the present disclosure can generate and/or providedesired flow profiles by configuring, modifying, optimizing, and/orfactoring in, amongst other things, (1) the rapid opening and closingthe flow valve, (2) transient wave generation and/or propagation inresponse to the rapid opening and closing the flow valve, (3) thelocation of the flow valve upstream or downstream of the orifice, (4)the including and/or adjusting of a volumetric offset separating theflow valve from the orifice, and (5) the flow of a volume of gasaffiliated with the volumetric offset, to name a few. Any of thesevariables and/or aspects can be configured, modified, optimized, and/orfactored in to generate and/or provide desired flow profiles to patientssuffering from COPD, IPF, CF, and PH, to name a few.

Further, in exemplary embodiments, systems and methods of the presentdisclosure can be used to modify and/or enhance previous systems and/ormethods used to deliver pulse doses of a pharmaceutical gas so they cangenerate and/or provide these desired flow profiles without requiringsubstantially expensive components (e.g., expensive valve assemblies,etc.) and/or by utilizing newly discovered properties and/or techniquesso the previous systems and/or methods can be enhanced, for example,without necessarily including substantially expensive components.

To provide and/or generate desired flow profiles, systems and methods ofthe present disclosure can use, modify, and/or be affiliated withvarious systems for delivering a pulse of a pharmaceutical gas to apatient. For example, systems and methods of the present disclosure canuse, modify, and/or be affiliated with the teachings of U.S. Pat. No.7,523,752 entitled “System and Method of Administering a PharmaceuticalGas To A Patient”, the content of which is incorporated herein byreference in its entirety and at least partially reproduced below. Forease, the systems and methods are disclosed, at times, as being usedwith, modifying, and/or being affiliated with the teachings of U.S. Pat.No. 7,523,752. This is merely for ease and is in no way meant to be alimitation.

In exemplary embodiments, providing and/or generating desired flowprofiles for pulse doses of pharmaceutical gas, systems and methods ofthe present disclosure can determine, factor in, and/or allow setting ofa desired quantity and/or duration of pharmaceutical gas therapy. Forexample, referring now to FIG. 2A, a front panel 10 of an apparatus isillustrated that can be modified and/or used in carrying out exemplaryembodiments of the present disclosure. Front panel 10 can be a part ofthe apparatus and on that panel there can be input settings (e.g., inputknobs) and displays which can allow the user to set and monitor theamount of pharmaceutical gas to be delivered to the patient.

The desired quantity of pharmaceutical gas to be delivered can be setand/or determined using a setting control including an input settingknob 12 and/or the set amount can be shown on the setting display 8. Theunits shown in FIG. 2A can be in milligrams per kilogram. The units canbe measured in a dosage per kilogram of the patient's ideal body weight.Along with that input, there can be a further input 14 whereby the usercan enter the patient's ideal body weight in kilograms and/or the amountcan also displayed on the setting display 8. With those inputs, the usercan set the quantity of the pharmaceutical gas to be administered to thepatient in proportion to the size of the patient. This can be done toreduce the patient to patient variability in response to thepharmaceutical gas due to the size of the patient (i.e. a 7 kilogrambaby will not be administered the same quantity of the pharmaceuticalgas as a 80 kilogram adult).

Front panel 10 can also have a monitor display 6 which can display totaldose of pharmaceutical gas (mg) to be delivered (e.g., shown at 16) ascalculated for multiplying the dosage/kg by the patients ideal bodyweight in kg.

Once the desired quantity of gaseous drug has been set on the device thesystem can then determine the amount of pharmaceutical gas to bedelivered in each breath and the amount of time and/or the number ofbreaths that it may take to deliver the total desired quantity of drug.Monitor display 6 can also display a running total of the delivered doseof pharmaceutical gas (mg) (e.g., shown at 17) as delivered to thepatient so the user can monitor the progress of the treatment. This canbe updated each breath as more pharmaceutical gas is delivered.

As stated, the units illustrated in FIG. 2A can be metric units,however, it will be understood that other units of mass and volume couldbe used in carrying out the present disclosure i.e. ounces and cubicinches and other designs of a front panel can be used as will later beunderstood.

Referring to FIG. 2B, a similar front panel 10 for the apparatus asshown in FIG. 2A is depicted illustrating a different user settingoption. The desired quantity of pharmaceutical gas to be delivered tothe patient can be prescribed as a rate of delivery that can be setand/or determined using a setting control that can include an inputsetting knob 13 that can be in units of mass per time such as mg/hr ofpharmaceutical gas to be delivered. In this option, the device can allowthe time duration (e.g., in hours) of treatment to be set and/ordetermined, for example, using an input setting knob 15. If required,the input setting by input setting knob 15 could be set to continuouswhere the dose per hour would run continuously until the user changedthe setting. With these input settings, the apparatus can calculateand/or display the desired quantity of the pharmaceutical gas to beadministered to the patient.

Also, as in FIG. 2A, front panel 10 can also have a monitor display 6which can display total dose of pharmaceutical gas (e.g., in mg) to bedelivered (e.g., shown at 16) as calculated by multiplying the dosage/hrby the total time duration (e.g., hr.). Once the desired quantity ofpharmaceutical gas has been set on the device, the system can thendetermine the amount of pharmaceutical gas to be delivered in eachbreath and the amount of time and/or the number of breaths that it willtake to deliver the total desired quantity of drug. As before, monitordisplay 6 can display a running total of the delivered dose ofpharmaceutical gas (mg) (e.g., shown at 17) as it is delivered to thepatient so the user can monitor the progress of the treatment. This canbe updated each breath as more pharmaceutical gas is delivered.

As can be appreciated, FIGS. 2A and 2B illustrate two of the manyoptions for setting the desired quantity and duration of pharmaceuticalgas therapy. These options are not meant to be exhaustive and there areother setting options described or that can be understood from thedetailed descriptions that follow.

In exemplary embodiments, providing and/or generating desired flowprofiles for pulse doses of pharmaceutical gas, systems and methods ofthe present disclosure can, determine, factor in, and/or allow settingof an amount of pharmaceutical gas to be delivered in each breath and anamount of time, and/or the number of breaths that it will take todeliver the desired quantity of pharmaceutical gas. For example, oncethe desired quantity of gaseous drug has been set and/or determined, thegas control system can then determine the amount of pharmaceutical gasto be delivered in each breath and the amount of time and/or the numberof breaths that it will take to deliver the desired quantity ofpharmaceutical gas.

There are a number of different approaches that the gas control systemcan use to determine the amount per breath and how long to deliver thatdose so the desired quantity of pharmaceutical gas can be deliveredindependent of the respiratory pattern of the patient:

a) The user can set the quantity of pharmaceutical gas to be deliveredduring each breath (M_(pg) breath) and the gas control system cancalculate the number of breaths (n_(breaths)) which will be required todeliver the total quantity of pharmaceutical gas (M_(pg)) i.e.

n _(breaths) =M _(pg) /M _(pg breath)  (5)

Once the total number of breaths (n_(breaths)) required has beendetermined the value can be displayed on the front panel 12 by way ofdisplay 16 to inform the user of the number of breaths.

b) The user can set the number of breaths (n_(breaths)) that willadminister the total quantity of the pharmaceutical gas and the systemcalculates the amount per breath (M_(pg breath)) to be delivered.

M _(pg breath) =M _(pg) /n _(breaths) (mg)  (6)

Once the amount per breath (M_(pg breath)) to be delivered has beendetermined, the value can be displayed on the front panel 10 to informthe user of the amount.

(c) The user could set the time duration for which the treatment is tobe delivered over. The amount per breath may then be determined bycalculating the quantity per minute and then, for example, by monitoringthe patient's respiration rate in breaths per minute, the amount perbreath can be calculated. This calculation can be repeated after everybreath so any changes in the patients respiratory rate does not affectthe overall quantity of gaseous drug being delivered.

d) If the desired quantity of pharmaceutical gas was entered as a doseper Kg of the patient's ideal body weight (μg/kg) along with thepatient's ideal body weight (Kg) then the amount per breath(M_(pg breath)) can be determined as a function of the patient's idealbody weight (IBW), the set dose per kilogram (M_(kg)) and the patient'smonitored respiratory rate (RR) or combinations thereof;

M_(pg) breath=f (IBW, M_(kg), RR) and the number of breaths can then becalculated as;

n _(breaths) =M _(pg) /M _(pg breath)  (7)

Once the amount per breath (M_(pg) breath) and the number of breaths(n_(breaths)) required to be delivered has been determined, the valuescan be displayed on the front panel 10 to inform the user of the amountsthe device has selected.

e) Instead of the ideal body weight (IBW) of the patient, the height andsex of the patient could be entered (which is how IBW is determined).

f) If the desired quantity of pharmaceutical gas per unit of time isentered into the device, then the device can calculate the quantity perbreath to be delivered to the patient based on the current monitoredrespiratory breath rate (as determined by the breath trigger sensor).This quantity per breath can be recalculated after every breath when newinformation on the respiratory rate is available to ensure the quantityper unit of time is maintained even if the patient respiratory breathpattern changes over time.

g) There can also be other ways of varying the quantity ofpharmaceutical gas delivered per breath to ensure the quantity per unitof time is maintained even if the patients respiratory rate changes.Another example may be where the device has two different amounts ofdelivery per breath, a high amount and a low amount. The device chooseswhich one to use based on the calculated quantity per unit of time beingdelivered over the past number of breaths. If the amount per unit oftime is greater than required, it uses the low amount per breath untilthe situation corrects itself; likewise, if the quantity per unit oftime is running low, then the unit switches to the high amount perbreath.

The device can also have programmed limits which restrict the maximumand minimum values that can be selected for M_(pg) breath so that thesystem doesn't select inappropriately too high or too low values. Theselimits can be set to vary based on the patient's ideal body weight, orother indicator of the patient size such as the patient's height, or therespiratory rate of the patient.

The aforesaid information can be utilized to deliver the dose to thepatient and to determine the amount per breath, time of administration,and/or other parameter in order to commence the administration ofpharmaceutical gas and/or to terminate that administration when the userset quantity of the pharmaceutical gas has been delivered to thepatient. Further, in exemplary embodiments, doses delivered to thepatient can be provided and/or generated in pulses of pharmaceutical gasthat can include desired flow profiles.

Turning now to FIG. 3, there is shown a schematic of a system comprisingvarious elements that can be used and/or modified to carry out variousexemplary embodiments of the present disclosure, for example, when thepatient is breathing spontaneously and/or that can be used and/ormodified to provide and/or generate desired flow profiles for pulsedoses of pharmaceutical gas, for example, when the patient is breathingspontaneously. As can be seen, a patient device 18 can deliver thedosage of the pharmaceutical gas from a gas delivery system 22 to apatient 41 via a gas conducting conduit 19. As indicated, patient device18 can be any one of a variety of devices that may actually direct thepharmaceutical gas into the patient and/or may be a nasal cannula, amask, an endotracheal tube and the like, to name a few.

In exemplary embodiments, there can be a source of the pharmaceuticalgas that can be a gas supply tank 20 containing the pharmaceutical gasgenerally in a carrier gas. When the pharmaceutical gas is carbonmonoxide, for example, the conventional, commercially available carriergas may be air. The supply of carbon monoxide and air can be provided inconcentrations of 3000 ppm however, concentrations within the range of1000 to 5000 ppm of pharmaceutical gas in air may also be possiblealternatives. In the case of NO as the pharmaceutical gas, the carriergas may be nitrogen and that may be available in concentrations rangefrom 100 ppm to 5000 ppm. Of course other concentrations can be usedand/or provided.

Accordingly, from supply tank 20, there can be a tank pressure gauge 21and a regulator 23 to bring the tank pressure down to the workingpressure of gas delivery system 22. The pharmaceutical gas can enter gasdelivery system 22 through an inlet 24 that can provide a readyconnection between delivery system 22 and supply tank 20 via a conduit.Gas delivery system 22 can have a filter 25 to ensure no contaminantscan interfere with the safe operation of the system and/or a pressuresensor 27 to detect if the supply pressure is adequate and canthereafter include a gas shut off valve 26 as a control of thepharmaceutical gas entering deliver system 22 and to provide safetycontrol in the event delivery system 22 is over delivering thepharmaceutical gas to the patient. In the event of such over delivery,shut off valve 26 can be immediately closed and an alarm 42 can besounded to alert the user that the gas delivery system has beendisabled. As such, shut off valve 26 can be a solenoid operated valvethat can be operated from signals directed from a central processingunit including a microprocessor.

Downstream from shut off valve 26 can be a flow control system thatcontrols the flow of the pharmaceutical gas to the patient throughpatient device 18. In exemplary embodiments, the flow control system cancomprise a first flow control valve that can be a high flow controlvalve 28 and a second flow control valve that can be a low control valve30 and just downstream and/or upstream (not shown) from flow controlvalves 28, 30, respectively, there can be a first flow orifice that canbe a high flow orifice 32 and a second flow orifice that can be a lowflow orifice 34. The purpose and use of the flow valves 28, 30 and floworifices 32, 34 will be later explained. A gas flow sensor 36 can alsobe located in the flow of pharmaceutical gas to patient device 18 and,as shown, can be downstream from the flow control system, however, gasflow sensor 36 may alternatively be located upstream of the flow controlsystem.

In exemplary embodiments, volumetric offset (e.g., volumetric offset 33and 35) can be located between and/or can separate flow valves (e.g.,flow valves 28 and 30) from orifices (e.g., flow orifices 32 and 34)such that a volume of gas can be in the volumetric offset. The purposeand use of volumetric offset 33 and 35 as well as flow valves 28, 30 andflow orifices 32, 34 will be later explained.

Next, there can be a patient trigger sensor 38. When the patientbreathes in during inspiration it can create a small sub atmosphericpressure in the nose or other area where patient device 18 is located,and hence in patient device 18 itself. Patient trigger sensor 38 candetect this pressure drop and can provide a signal indicative of thestart of inspiration of the patient. Similarly, when the patientbreathes out there can be a positive pressure in patient device 18 andpatient trigger sensor 38 can detect that positive pressure and canprovide a signal indicative of the beginning of expiration. This canallow patient trigger sensor 38 to determine not only the respiratoryrate of the patient but also the inspiratory times and/or expiratorytimes. It will be understood that other techniques can be used todetermine the respiratory rate of the patient, inspiratory times, andexpiratory times, and/or other aspects of patient breathing.

Finally there can be a central processing unit (CPU) 40 that cancommunicate with patient trigger sensor 38, flow valves 28, 30, gas shutoff valve 26, and other components in order to carry out variousexemplary embodiments of the present disclosure. CPU 40 can include aprocessing component such as a microprocessor to carry out all of thesolutions to the equations that can be used by the gas delivery system22 to deliver the predetermined quantity of the pharmaceutical gas to apatient. The CPU 40 can be connected to the front panel 10 where theuser can enter settings and monitor therapy.

In exemplary embodiments, various elements of delivery system 22 can beused and/or modified to carry out various exemplary embodiments of thepresent disclosure when spontaneous breathing occurs. Also, in exemplaryembodiments, various elements of delivery system 22 can be used and/ormodified to provide and/or generate desired flow profiles for pulses ofpharmaceutical gas. By way of example, when delivery system 22 detects,(e.g., by way of patient trigger sensor 38) that inspiration hasstarted, a signal can be provided to CPU 40 to deliver a dose of apharmaceutical gas (M_(pg) breath) into the patient's inspiratory gasflow, preferably during the first ½ of the inspiratory cycle. Thisamount per breath can have been determined based on the desired quantityof pharmaceutical gas that may have been set on the system and thecalculations made in a) to g) described earlier.

The actual volume of gas delivered during the breath can depend on theconcentration of the pharmaceutical gas in the carrier gas supplied bysupply tank 20. A typical source concentration (C_(pg)) forpharmaceutical gas can be 3000 ppm (range 500 to 5000). The volume ofsource gas (V_(d)) per breath to provide a dose per breath (M_(pg)breath) when the source of pharmaceutical gas is 3000 ppm can be givenby the following equation, combining equations 2, 3, 4 and 6;

V _(d) =M _(pg breath)/(28·C _(pg)·4·16×10⁻¹¹)  (8)

Given that M_(pg)=60×10⁻³ (g), C_(pg)=3000 (ppm), n_(breaths)=600, thenV_(d)=28.6 (mL).

To deliver the volume of source gas per breath (V_(d)), that is, thepharmaceutical gas and the carrier gas, delivery system 22 can open aflow control valve, such as a first flow valve that can be high flowvalve 28 and/or a second flow valve that can be a low flow valve 30 toallow the gas to flow to the patient until the volume per breath (V_(d))has been delivered. The presence of the first flow orifice that can behigh flow orifice 32 and the second flow orifice that can be low floworifice 36 can limit the flow of gas to a fixed set level during theperiod that flow valves 28, 30 are open so delivery system 22 candetermine the period of time flow valves 28, 30 should be open todeliver the volume per breath (V_(d)) required. Also, the flow can bedetermined by gas flow sensor 36 to monitor the gas flow to patientdevice 18 and thus to the patient and can shut off the appropriate flowcontrol valve 28, 30 when the desired predetermined quantity ofpharmaceutical gas dose has been delivered to the patient.

In exemplary embodiments, to provide enough range to cover all thepossible doses, the use of multiple flow valves such as, but not limitedto, flow valve 28 and flow valve 30 along with corresponding multipleorifices, flow orifice 32 and flow orifice 34, can be used in parallelso as to provide ranges of gas flow. For instance, gas flow through flowvalve 30 could be set to 1 L/min and gas flow through flow control valve28 could be set to 6 L/min. The flow range of the particular gas flowvalve can be selected to ensure that the volume of gas per breath(V_(d)) can be delivered to the patient in at least ½ the inspiratorytime.

As an example, if the patient was breathing at 12 breaths per minute andhad an I:E ratio of 1:2 then the inspiratory time would be 1.66 secondsand half that would be 0.83 seconds.

The time (t) taken to deliver a V_(d) of 28 mL can be calculated asfollows.

t=V _(d) 60/(Q·1000) (secs)  (9)

When Q (the flow of gas when the flow valve 28 is open)=6 L/mins t=0.28(secs).

That time is therefore well within ½ the inspiratory time allowed of0.83 seconds.

Delivery system 22 can also include monitoring and alarm features toalert the user if delivery system 22 is, for example, not workingcorrectly. Those alarm conditions can be determined by CPU 40 and/oralarm 42 can be activated to alert the user to the particular faultcondition. Alarm 42 can be audible, visual or both and the alarmconditions can be any one or all of the following: No breath detectedLow source gas pressure Inaccurate delivery of the volume per breath(V_(d)), Over delivery of the volume per breath (V_(d)), Under deliveryof the volume per breath (V_(d)), to name a few.

Under certain conditions, such as when the delivery system 22 is overdelivering the pharmaceutical gas, CPU 40 may signal gas shut off valve26 and immediately cease any further delivery of the pharmaceutical gasand/or alarm 42 may also be activated.

The use of alarm 42 can also be an alternative to actually shutting offthe supply of the pharmaceutical gas to a patient when the predetermineddesired quantity of pharmaceutical gas has been fully delivered to thepatient. In such case, as an alternative to ceasing the further supplyof the pharmaceutical gas to the patient, delivery system 22 may, by wayof CPU 40, activate alarm 42 to alert the user that the totalpredetermined desired quantity of the pharmaceutical gas has beendelivered. The user can then determine whether to manually deactivatedelivery system 22 or continue the delivery of the pharmaceutical gas,for example, under more watchful control of the patient's status.

Turning now to FIG. 4, there is shown a schematic view of a gas deliverysystem 44 used in conjunction with a patient being breathed by aventilator 46. Various elements of gas delivery system 44, used inconjunction with ventilator 46, can used and/or modified to provideand/or generate desired flow profiles for pulses of pharmaceutical gas.Similar to FIG. 3, again there is a supply tank 20 that can include aconventional gas regulator 23 and a pressure gauge 21 to supply thepharmaceutical gas along with the carrier gas to an inlet 24 in gasdelivery system 44. Briefly summarizing the components of the FIG. 4,since they may be basically the same components as described withrespect to the FIG. 3, there can be a filter 25 and a pressure sensor 27in gas delivery system 44. Again there can be a shut off valve 26 tocontrol the overall flow of the pharmaceutical gas through gas deliverysystem 44.

Flow control valves 28 and 30 can control the flow of the pharmaceuticalgas through gas delivery system 44 and, flow valves 28, 30 can operateas described with respect to the FIG. 3 with flow orifices 32, 34located downstream and/or upstream (not shown) of the flow controlvalves.

Further, volumetric offset 33 and 35 can be located between and/or canseparate flow valves 28 and 30 flow orifices 32 and 34 such that avolume of gas can be in the volumetric offset.

Again there can be a gas flow sensor 36 and/or a patient trigger sensor66, both of which can communicate with a CPU 40. In exemplaryembodiments, the pharmaceutical gas can be carried through an outletconduit 70 to a patient device 72 that can also receive breathing gasfrom ventilator 46. As such, ventilator 46 can deliver a flow of gasthrough an inspiratory limb 74 and gas can be returned to ventilator 46through an expiratory limb 76.

The flow of gas from ventilator 46 can thus be supplemented by the flowof pharmaceutical gas from gas delivery system 44 where that gas may bemixed at, or proximate to, patient device 72 for introduction intopatient 78. Since the pharmaceutical gas can be delivered to the patientover the plurality of breaths, as disclosed above, CPU 40 can carry outthe same and/or similar determinations of flows and the like asexplained with respect to the FIG. 3. A difference between FIG. 4 andthat shown in FIG. 3 is that the patient trigger sensor 66 can bedesigned to operate in a way that works with ventilator 46.

For instance, when ventilator 46 provides gas flow to a patient duringinspiration, it can cause a positive pressure in the breathing circuit.The positive pressure can be conducted through outlet conduit 70 and canbe detected by patient trigger sensor 66 and can be recognized as thestart of inspiration. This is unlike exemplary embodiments of FIG. 3where the patient breathes spontaneously and a negative pressure can begenerated during inspiration in patient device 18; this negativepressure can be conducted to patient trigger sensor 38 of FIG. 3 and canbe recognized as the start of inspiration. As can be appreciated,patient trigger sensor 38 of FIG. 3 and patient trigger sensor of FIG. 4could be the same pressure sensor and gas delivery system 44 can be setfor work with a ventilator or a spontaneously breathing patient.

In exemplary embodiments, the shape and/or properties of desired flowprofiles generated and/or provided by a pharmaceutical gas deliverysystem can be based on aspects such as, but not limited to, spatialrelationships of elements of the fixed flow rate assembly, rate of valveclosure and opening, latent flows, and/or transient wave generationand/or propagation. By way of example, systems and methods of thepresent disclosure can generate and/or provide desired flow profiles byconfiguring, modifying, optimizing, and/or factoring in, amongst otherthings, (1) the rapid opening and closing the flow valve, (2) transientwave generation and/or propagation in response to the rapid opening andclosing the flow valve, (3) the location of the flow valve upstream ordownstream of the orifice, (4) the including of a volumetric offsetseparating the flow valve from the orifice, and (5) the flow of a volumeof gas affiliated with the volumetric offset.

Using systems and methods of the present disclosure variables and/oraspects can be configured, modified, optimized, and/or factored in togenerate and/or provide desired flow profiles to patients suffering fromCOPD, IPF, and PAH, to name a few. At times, the name of a specificdisease may not be provided; however, this is merely for ease.

Referring to FIG. 5A-9D, in exemplary embodiments, a desired flowprofile that is substantially polygonal in shape can be generated and/orprovided such that it includes an initial flow spike, as shown in FIGS.5B, 6B, and 6D, and/or a waning flow, as shown in FIGS. 5D, 7B, 7D, 9B,and 9D, and/or a substantially rectangular shape, as shown in FIGS. 8Band 8D. The shape of the desired flow profile as well as attributes suchas an initial flow spike and/or a waning flow can be generated and/orproduced in response to, amongst other things, configuring apharmaceutical gas delivery system such that the location of a firstfixed flow valve 502 (e.g., flow valve 28, flow valve 30, etc.) can beupstream or downstream of a first fixed flow orifice 504 (e.g., a highflow orifice 32, low flow orifice 34, etc.) with a volumetric offset 506located between and/or separating first fixed flow valve 502 and firstfixed flow orifice 504 whereby first fixed flow valve 502 is rapidlyopened and closed.

Referring to FIGS. 5A-5B, in exemplary embodiments, to generate and/orprovide a desired flow profile 508 that includes an initial flow spike510, a pharmaceutical gas delivery system can be configured to include avolumetric offset 506 located between and/or separating a first fixedflow orifice 504 located upstream to a first fixed flow valve 502, firstfixed flow valve 502 being capable of rapidly actuating. In thisconfiguration, desired flow profile 508 that includes initial flow spike510 can be generated and/or provided to a patient by rapidly openingfirst fixed flow valve 502 at time (T1) to flow (Q1) causing an initialflow spike 510 of flow (Q2) of transient therapeutic gas to be generatedand/or propagated to the patient. In exemplary embodiments, the volumeof flow (Q2−Q1 for T2−T1) associated with initial flow spike 510 can besubstantially equal to the volume in volumetric offset 506. In exemplaryembodiments, this volume can be set to a desired amount to provide aspecific initial flow spike to a patient.

Still referring to FIGS. 5A-5B, following desired flow profile 508,therapeutic gas flow can be provided to the patient for a duration oftime (e.g., T2 to T3) until first fixed flow valve 502 is closed rapidlyat T3 causing a sharp cutoff in flow of therapeutic gas to the patient.

Referring to FIGS. 5C-5D, in exemplary embodiments, to generate and/orprovide a desired flow profile 512 that includes a waning flow 514, apharmaceutical gas delivery system can be configured to include avolumetric offset 506 located between and/or separating a first fixedflow orifice 504 located downstream to a first fixed flow valve 502,first fixed flow valve 502 being capable of rapidly actuating. In thisconfiguration, desired flow profile 512 can be generated and/or providedto a patient by rapidly opening first fixed flow valve 502 at time (T1)to flow (Q1) and continuing to flow therapeutic gas to a patient for aduration of time (e.g., T1 to T2).

Still referring to FIGS. 5C-5D, in exemplary embodiments, at time (T2)first fixed flow valve 502 can be closed rapidly ceasing flow throughfirst fixed flow valve 502 while a volume of waning flow 514 can beprovided to the patient until T3. In exemplary embodiments, the volumeof flow associated with waning flow 514 can have a volume substantiallyequal to a volume in volumetric offset 506. In exemplary embodiments,this volume can be set to a desired amount to provide a specific waningflow to a patient.

Referring to FIGS. 6A-6D, in exemplary embodiments, the volume of flow(Q2−Q1 for T2−T1) associated with initial flow spike 510 of desired flowprofile 508 can be adjusted by varying the amount of volumetric offset506, and therefore volume, between and/or separating first fixed flowvalve 502 and first fixed flow orifice 504. Referring to FIGS. 6A-6B,the volume of flow (Q2−Q1 for T2−T1) associated with initial flow spike510 can be augmented by increasing the amount of volumetric offset 506,and therefore volume, between and/or separating first fixed flow valve502 and first fixed flow orifice 504. Referring to FIGS. 6C-6D, thevolume of flow (Q2−Q1 for T2−T1) associated with initial flow spike 510can be reduced by decreasing the amount of volumetric offset 506, andtherefore volume, between and/or separating first fixed flow valve 502and first fixed flow orifice 504. Q2 may change as a result of varyingthe amount of volumetric offset 506 and/or Q2 may constant as the amountof volumetric offset 506 is varied with only the volume of flow (Q2−Q1for T2−T1) associated with initial flow spike 510 changing.

Referring to FIGS. 7A-7D, in exemplary embodiments, the volume of flowassociated with waning flow 514 of desired flow profile 514 can beadjusted by varying the amount of volumetric offset 506, and thereforevolume, between and/or separating first fixed flow valve 502 and firstfixed flow orifice 504. Referring to FIGS. 7A-7B, the volume of flowassociated with waning flow 514 can be augmented by increasing theamount of volumetric offset 506, and therefore volume, between and/orseparating first fixed flow valve 502 and first fixed flow orifice 504.Referring to FIGS. 7C-7D, the volume of flow associated with waning flow514 can be reduced by decreasing the amount of volumetric offset 506,and therefore volume, between and/or separating first fixed flow valve502 and first fixed flow orifice 504.

In exemplary embodiments, the shape and/or slope of waning flows and/orinitial flow spikes can be modified and/or based on aspects of fixedflow rate assemblies and/or a pharmaceutical gas delivery system. Inexemplary embodiments, waning flows and/or initial flow spikes can havelinear and/or exponential shapes by modifying elements of fixed flowrate assemblies and/or a pharmaceutical gas delivery system such thatflow is laminar and/or non-laminar. To produce laminar and/ornon-laminar flow the ratio of the orifice's opening to tubingcross-section and/or volumetric offsets cross-section can be modified.To produce laminar and/or non-laminar flow the ratio of the shape oforifices and/or elements of fixed flow rate assemblies and/or apharmaceutical gas delivery system can be modified.

As can be taken from FIGS. 6A-D and 7A-D, reducing the amount ofvolumetric offset 506 can adjust the flow profile to decrease theinitial flow spike 510 and/or the waning flow 514. Accordingly, inexemplary embodiments, the amount of volumetric offset 506 can beminimized such that the initial flow spike 510 and/or the waning flow514 is minimized, and thus producing a desired flow profile 508 or adesired flow profile 512 that is substantially rectangular in shape(e.g. a pulse wave).

Referring to FIGS. 8A-D, in exemplary embodiments, the volumetric offset506 is negligible (and therefore not shown) such that the desired flowprofile 508 or 512 is substantially rectangular in shape. As can be seenfrom FIGS. 8A-8B (first fixed flow orifice 504 located upstream fromfirst fixed flow valve 502) and FIGS. 8C-8D (first fixed flow orifice504 located downstream from first fixed flow valve 502), a pulse wavecan be generated by having the first flow orifice 504 either upstream ordownstream from the first fixed flow valve 502.

Accordingly, in exemplary embodiments, the amount of volumetric offsetcan be less than or equal to a certain volume, such as less than orequal to any of the following volumes: 5 mL, 4 mL, 3 mL, 2 mL, 1.5 mL, 1mL, 0.9 mL, 0.8 mL, 0.7 mL, 0.6 mL, 0.5 mL, 0.4 mL, 0.3 mL, 0.2 mL, 0.15mL, 0.1 mL, 0.09 mL, 0.08 mL, 0.07 mL, 0.06 mL, 0.05 mL, 0.04 mL, 0.03mL, 0.02 mL, 0.015 mL, 0.01 mL, 0.009 mL, 0.008 mL, 0.007 mL, 0.006 mL,0.005 mL, 0.004 mL, 0.003 mL, 0.002 mL, 0.0015 mL, 0.001 mL or 0.0005mL.

In exemplary embodiments, smaller volumetric offsets can be used whenthe expected pulse of pharmaceutical gas is small, to ensure that anyinitial pulse spike and/or waning flow is only a small portion of thetotal pulse volume. For example, the volume of the pulse ofpharmaceutical gas depends on the concentration of the pharmaceuticalgas and the desired dose of pharmaceutical gas. Higher concentrations ofpharmaceutical gas can result in smaller pulse volumes, and thus thevolumetric offset can be smaller in pharmaceutical gas delivery systemsthat are designed to have small minimum pulse volumes or small averagepulse volumes. Exemplary pulse volumes may be in the range of 0.1 mL to30 mL, such as 30 mL, 25 mL, 20 mL, 15 mL, 10 mL, 9 mL, 8 mL, 7 mL, 6mL, 5 mL, 4 mL, 3 mL, 2 mL, 1 mL, 0.9 mL, 0.8 mL, 0.7 mL, 0.6 mL, 0.5mL, 0.4 mL, 0.3 mL, 0.2 mL or 0.1 mL.

In exemplary embodiments, the volumetric offset is only a certainproportion of a minimum pulse volume, average pulse volume, or maximumpulse volume that is expected for the pharmaceutical gas deliverysystem. In some embodiments, the volumetric offset has a volume that isless than or equal to a certain percentage of the minimum pulse volume,average pulse volume, or maximum pulse volume, such as less than orequal to any of the following percentages: 50%, 40%, 30%, 25%, 20%, 15%,10%, 9%, 8%, 7%, 6%, 5%, 4%, 3%, 2%, 1%, 0.9%, 0.8%, 0.7%, 0.6%, 0.5%,0.4%, 0.3%, 0.2%, 0.1%, 0.05% or 0.01%.

For some pharmaceutical gases and some diseases, it can be desired thatthe pulse of pharmaceutical gas is only delivered during a portion ofthe patient's inspiration, such as during the first ½ of inspiration,first ⅓ of inspiration, first ¼ of inspiration, etc. Accordingly,minimizing or eliminating the waning flow of a pulse volume can helpensure that the entire pulse of pharmaceutical gas is delivered duringthe desired window. In various embodiments, the entire pulse width (e.g.T1 to T3) is within a certain range, such as 10 milliseconds (msec) to 2seconds (sec). Exemplary values within this range include 10 msec, 20msec, 30 msec, 40 msec, 50 msec, 60 msec, 70 msec, 80 msec, 90 msec, 100msec, 150 msec, 200 msec, 250 msec, 300 msec, 350 msec, 400 msec, 450msec, 500 msec, 600 msec, 700 msec, 800 msec, 900 msec, 1 sec, 1.5 secor 2 sec.

Referring to FIG. 9A-9D, in exemplary embodiments, a desired flowprofile that is substantially triangular in shape can be provided and/orgenerated. In exemplary embodiments, with first fixed flow orifice 504located downstream to first fixed flow valve 502 a substantiallytriangular desired flow profile can be generated and/or provided having(1) a sharp turn on of flow (Q1) provided to a patient by rapidlyopening first fixed flow valve 502 at T1, (2) negligible flow can thenbe provided for a de minimis duration of time, and (3) after first fixedflow valve 502 closes rapidly at T2 flow through first fixed flow valve502 can cease while the volume associated with waning flow 514 cancontinue to be provided to the patient until T3. Similar to above, thevolume associated with waning flow 514 of a triangular desired flowprofile can be adjusted by varying the amount of volumetric offset 506,and therefore volume, between and/or separating first fixed flow valve502 and first fixed flow orifice 504.

Referring to FIGS. 10A-10H, in exemplary embodiments, the volumeassociated volumetric offset 506 can increased and/or decreased byadjusting the relative separation of first fixed flow orifice 504 tofirst fixed flow valve 502 and/or modifying the shape of volumetricoffset 506. For example, referring to FIGS. 10D and 10H, the volume ofvolumetric offset 506 can increased and/or decreased by adjusting therelative separation of first fixed flow orifice 504 to first fixed flowvalve 502. For another example, referring to FIGS. 10A-10C and 10E-10Gthe volume of volumetric offset 506 can increased and/or decreased bymodifying the shape of volumetric offset 506 between first fixed floworifice 504 to first fixed flow valve 502.

Referring to FIGS. 11A-11B, in exemplary embodiments, the volumetricoffset can be a volume located off of a connection between and/orseparating first fixed flow orifice to a first fixed flow valve. Forexample, volumetric offset 506 can be a separate reservoir providingvolume between and/or separating first fixed flow orifice to a firstfixed flow valve. For ease, at times, the volumetric offset isillustrated and/or described as being a volume between and/or separatinga first fixed flow orifice to a first fixed flow valve. This is merelyfor ease and is in no way meant to be a limitation.

It will be understood that the volume associated with the volumetricoffset can be increased and/or decreased by modifying the shape of thevolumetric offset, the volumetric offset can be any shape, and/or theshape of the volumetric offset can be selected to modify the shapeand/or properties of desired flow profiles generated and/or provided bya pharmaceutical gas delivery system. For ease, at times, the volumetricoffset is illustrated and/or described as being increased and/ordecreased by adjusting the relative separation of, and therefore volume,a first fixed flow orifice to a first fixed flow valve. This is merelyfor ease and is in no way meant to be a limitation.

In exemplary embodiments, systems and methods of the present disclosurecan generate and/or provide desired flow profiles having varying flowrates using fixed flow valves. These desired flow profiles can provideflow rates beyond those of the on and off values of fixed flow valvesused and/or associated with a pharmaceutical gas delivery system. By wayof example, as described herein, pharmaceutical gas delivery systemsusing, for example, fixed flow assemblies can provide varying flow ratesby taking into account spatial relationships of elements of the fixedflow rate assembly, rate of valve closure and opening, latent flows,transient wave generation and/or propagation, to name a few. This canallow for, amongst other things, more complex flow profiles withoutusing expensive components (e.g., proportional flow valves)

Further, in exemplary embodiments, systems and methods of the presentdisclosure can generate and/or provide desired flow profiles havingvarying flow rates using multiple fixed flow valves. These desired flowprofiles can provide flow profiles with flow rates beyond those of theon and off values, and/or cumulative on and off values, of the multiplefixed flow valves. At times, only one or two fixed flow valves aredescribed. This is merely for ease and is in no way meant to be alimitation.

In exemplary embodiments, substantially complex desired flow profilescan be generated and/or provided that can have varying flow rates usingfixed flow valves rather than proportional valves. Proportional valvescan be substantially more expensive than fixed flow valves, and may notbe as reliable and/or as predictable as fixed flow valves. Systems andmethods of the present disclosure can allow for generating and/orproviding substantially complex desired flow profiles withoutsubstantially increasing costs and/or without the use of substantiallyexpensive proportional valves. Accordingly, using systems and methods ofthe present disclosure, a pharmaceutical gas delivery system can befabricated and/or modified without including expensive components (e.g.,proportional valves, etc.) and/or by reducing the number of expensivecomponents used that can increase the cost of such systems, reduceavailability to the public, and/or utilize resources that may belimited.

In exemplary embodiments, systems and methods of the present disclosurecan generate and/or provide desired flow profiles having varying flowrates using one or more fixed flow valves as well as one or moreproportional valve. Various desired flow profiles can be generated bythe combination of one or more fixed flow valves with one or moreproportional valve. At times, only fixed flow valves are described. Thisis merely for ease and is in no way meant to be a limitation.

Those skilled in the art will readily recognize numerous adaptations andmodifications which can be made to the pharmaceutical gas deliverysystem and method of delivering a pharmaceutical gas of the presentdisclosure which will result in an improved method and system forintroducing a known desired quantity of a pharmaceutical gas into apatient, yet all of which will fall within the scope and spirit of thepresent disclosure as defined in the following claims. Accordingly, thedisclosure is to be limited only by the following claims and theirequivalents.

Reference throughout this specification to “one embodiment,” “certainembodiments,” “one or more embodiments,” “exemplary embodiment,”“exemplary embodiments,” and/or “an embodiment” means that a particularfeature, structure, material, or characteristic described in connectionwith the embodiment is included in at least one embodiment of thedisclosure. Thus, the appearances of the phrases such as “in one or moreembodiments,” “in certain embodiments,” “in one embodiment,” “exemplaryembodiment,” “exemplary embodiments,” and/or “in an embodiment” invarious places throughout this specification are not necessarilyreferring to the same embodiment of the disclosure. Furthermore, theparticular features, structures, materials, or characteristics can becombined in any suitable manner in one or more embodiments.

It will be understood that any of the steps described can be rearranged,separated, and/or combined without deviated from the scope of thedisclosure. For ease, steps are, at times, presented sequentially. Thisis merely for ease and is in no way meant to be a limitation.

Further, it will be understood that any of the elements and/orembodiments of the disclosure described can be rearranged, separated,and/or combined without deviated from the scope of the disclosure. Forease, various elements are described, at times, separately. This ismerely for ease and is in no way meant to be a limitation.

Although the disclosure herein has been described with reference toparticular embodiments, it is to be understood that these embodimentsare merely illustrative of the principles and applications of thepresent disclosure. It will be apparent to those skilled in the art thatvarious modifications and variations can be made to the method andapparatus of the present disclosure without departing from the spiritand scope of the disclosure. Thus, it is intended that the presentdisclosure include modifications and variations that are within thescope of the appended claims and their equivalents.

What is claimed is:
 1. A system for providing a pulse of apharmaceutical gas having a desired flow profile to deliver to apatient, the system comprising: a first fixed flow rate assemblyincluding a first fixed flow valve in fluid communication with a firstfixed flow orifice, the first fixed flow valve being (1) a fixed flowvalve that rapidly opens and rapidly closes, (2) located upstream ordownstream of first fixed flow orifice and (3) at a volumetric offsetfrom the first fixed flow orifice; and a flow delivery control thatrapidly opens and rapidly closes the first fixed flow orifice located atleast one of upstream or downstream of, and at the volumetric offsetfrom, the first fixed flow valve to provide a pulse of a pharmaceuticalgas having a desired flow profile to a patient.
 2. The system of claim1, wherein the pulse of a pharmaceutical gas having a desired flowprofile is provided to a patient to treat at least one of chronicobstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis(IPF), and pulmonary hypertension (PH).
 3. The system of claim 1,wherein when the first fixed flow orifice is upstream to the first fixedflow valve at least one of (1) an initial flow spike in volume oftransient therapeutic gas substantially equal to the volume in thevolumetric offset is delivered when the first fixed flow valve is openedrapidly and (2) a sharp cutoff is provided when the first fixed flowvalve is closed rapidly.
 4. The system of claim 1, wherein when thefirst fixed flow orifice is downstream to the first fixed flow valve atleast one of (1) a sharp turn on is provided when the first fixed flowvalve is opened rapidly, and (2) a waning flow having a volumesubstantially equal to a volume in the volumetric offset is providedwhen the first fixed flow valve is closed rapidly.
 5. The system ofclaim 1, wherein when the first fixed flow orifice is upstream from thefirst fixed flow valve, the volumetric offset is substantially minimizedto decrease duration of a waning flow generated when the first fixedflow valve is closed rapidly.
 6. The system of claim 5, wherein thevolumetric offset has a volume of less than 1 mL.
 7. The system of claim6, wherein the volumetric offset has a volume in the range of 0.0005 mLto 0.1 mL.
 8. The system of claim 1, further comprising a dampener forringing.
 9. The system of claim 1, wherein the desired flow profile forthe pulse of pharmaceutical gas is one that minimizes the time that thefirst fixed flow valve is open.
 10. The system of claim 9, wherein thefirst fixed flow valve provides a pulse having a pulse width of lessthan 500 milliseconds.
 11. A method of providing a pulse of apharmaceutical gas with a desired flow profile to deliver to a patient,the method comprising: rapidly opening a first fixed flow valve that islocated upstream from a first fixed flow orifice to commence delivery ofa first dose of a pharmaceutical gas in a pulse having a desired flowprofile to a patient that abruptly increases flow to a desired initialflow rate over negligible time; rapidly closing the first fixed flowvalve to end flow, through the first fixed flow valve, of thepharmaceutical gas; and providing a waning flow of the pharmaceuticalgas after rapidly closing the first fixed flow valve to completedelivery, to the patient, of the pulse of the pharmaceutical gas withthe desired flow profile, wherein the waning flow is generated inresponse to arranging the first fixed flow valve at a volumetric offsetfrom the first fixed flow orifice such that the waning flow is at leastone of reduced by lessening the volumetric offset or increased byincreasing the volumetric offset.
 12. The method of claim 11, whereinthe pulse of a pharmaceutical gas having a desired flow profile isprovided to a patient to treat at least one of chronic obstructivepulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF), andpulmonary hypertension (PH).
 13. The method of claim 11, wherein thedesired flow profile is downwardly sloped triangular shaped.
 14. Themethod of claim 11, further comprising: maintaining open the first fixedflow valve to continue delivery, to the patient, of the pulse of thepharmaceutical gas with the desired flow profile at a desired continuedflow rate for a period of time.
 15. The method of claim 14, wherein thedesired flow profile is quadrilateral shaped.
 16. The method of claim15, wherein the volumetric offset has a volume of less than 1 mL and thequadrilateral is substantially rectangular shaped.
 17. A method ofproviding a pulse of a pharmaceutical gas with a desired flow profile todeliver to a patient, the method comprising: rapidly opening a firstfixed flow valve that is located downstream from a first fixed floworifice to commence delivery of a first dose of a pharmaceutical gas ina pulse having a desired flow profile to a patient that abruptlyincreases flow to a desired initial flow rate including an initial flowspike over negligible time, wherein the initial flow spike is generatedin response to arranging the first fixed flow valve at a volumetricoffset from the first fixed flow orifice such that the initial flowspike is at least one of reduced by lessening the volumetric offset orincreased by increasing the volumetric offset; and rapidly closing thefirst fixed flow valve to end flow, through the first fixed flow valve,of the pharmaceutical gas to complete delivery, to the patient, of thepulse of the pharmaceutical gas with the desired flow profile.
 18. Themethod of claim 17, wherein the pulse of a pharmaceutical gas having adesired flow profile is provided to a patient to treat at least one ofchronic obstructive pulmonary disease (COPD), idiopathic pulmonaryfibrosis (IPF), and pulmonary hypertension (PH).
 19. The method of claim17, further comprising: maintaining open the first fixed flow valve tocontinue delivery, to the patient, of the pulse of the pharmaceuticalgas with the desired flow profile at a desired continued flow rate for aperiod of time.
 20. The method of claim 17, wherein the desired flowprofile is quadrilateral shaped.